Yamashita Takeshi, Fujimasa Koichiro, Otsuka Koji, Saito Akira, Kohmoto Masahiro, Motegi Kentaro, Ariyoshi Tomotake, Goto Satoru, Yamochi Toshiko, Takimoto Masafumi, Hirasawa Yuya, Kubota Yutaro, Yoshimura Kiyoshi, Tsunoda Takuya, Murakami Masahiko, Aoki Takeshi
Esophageal Cancer Center, Showa Medical University Hospital, Tokyo, Japan.
Division of Gastroenterological and General Surgery, Department of Surgery, School of Medicine, Showa Medical University, Tokyo, Japan.
Anticancer Res. 2025 May;45(5):2051-2058. doi: 10.21873/anticanres.17579.
BACKGROUND/AIM: Esophageal neuroendocrine carcinoma (E-NEC) is a rare malignancy. Although treatment for E-NEC involves a combination of surgery, chemotherapy, radiotherapy, and immunotherapy, E-NEC prognosis is poor and the treatment strategy remains unclear. Surgery after neoadjuvant chemotherapy is the standard treatment for advanced esophageal squamous cell carcinoma; however, limited reports exist on its application for E-NEC. This study aimed to examine the surgical outcomes of patients with E-NEC based on the pathological findings of endoscopic biopsies before surgery and surgical specimens.
We examined patients who underwent thoracoscopic subtotal esophagectomy for esophageal or esophagogastric junction cancer and were diagnosed with E-NEC based on endoscopic biopsy or surgical pathology.
This study included 12 patients. Preoperative endoscopic biopsy confirmed a diagnosis of E-NEC in five patients. Six patients had a mixture of squamous cell carcinoma and NEC components (including suspected cases), and one patient had adenocarcinoma. Neoadjuvant chemotherapy was administered to 10 patients, including four who received 5-fluorouracil with cisplatin, three who received etoposide with cisplatin, two who received etoposide with carboplatin, and one who received S-1 with oxaliplatin. R0 resection was performed through thoracoscopic esophagectomy. Histopathological diagnosis after surgery identified NEC in eight patients, a mixed type in three patients, including MiNEN in two patients, and SCC in one patient. Recurrence occurred within one year in seven patients, and three of these patients died within one year due to hematogenous metastasis. The one-year overall survival rate was 67% (9/12 cases), and the median survival time was 41.7 months.
Esophagectomy combined with preoperative chemotherapy for E-NEC may contribute to improved prognosis.
背景/目的：食管神经内分泌癌（E-NEC）是一种罕见的恶性肿瘤。尽管E-NEC的治疗包括手术、化疗、放疗和免疫治疗的联合应用，但其预后较差，治疗策略仍不明确。新辅助化疗后手术是晚期食管鳞状细胞癌的标准治疗方法；然而，关于其在E-NEC中的应用报道有限。本研究旨在根据术前内镜活检和手术标本的病理结果，探讨E-NEC患者的手术疗效。
我们研究了因食管或食管胃交界癌接受胸腔镜下食管次全切除术，并根据内镜活检或手术病理诊断为E-NEC的患者。
本研究纳入12例患者。术前内镜活检确诊5例E-NEC。6例患者同时存在鳞状细胞癌和NEC成分（包括疑似病例），1例患者为腺癌。10例患者接受了新辅助化疗，其中4例接受5-氟尿嘧啶联合顺铂，3例接受依托泊苷联合顺铂，2例接受依托泊苷联合卡铂，1例接受S-1联合奥沙利铂。通过胸腔镜食管切除术进行了R0切除。术后组织病理学诊断显示8例为NEC，3例为混合型，其中2例为MiNEN，1例为SCC。7例患者在1年内复发，其中3例患者因血行转移在1年内死亡。1年总生存率为67%（9/12例），中位生存时间为41.7个月。
E-NEC的食管切除术联合术前化疗可能有助于改善预后。
